Key result
Residents show high stroke alteplase knowledge, yet ~10% hesitate to endorse it over bleeding risks.
Cross-Sectional (n=206)
Yes
Postgraduate residents in Khyber Pakhtunkhwa exhibit high foundational knowledge of alteplase therapy for acute ischemic stroke, but its clinical implementation remains constrained by lack of self-assurance, fears of hemorrhage, and medicolegal concerns.
High resident alteplase knowledge coexists with 10% hesitance; leaves open whether targeted training mitigates barriers to thrombolysis implementation.
Background: Acute ischemic stroke (AIS) is a predominant cause of death and prolonged disability, globally. Intravenous alteplase (tPA) is the mainstay treatment when administered within therapeutic timeframe. In low and middle-income countries like Pakistan, treatment delays frequently stem from insufficient awareness among healthcare professionals. This study evaluated the knowledge, attitudes, and behaviors of postgraduate residents at public and private hospitals of Khyber Pakhtunkhwa regarding the use of intravenous alteplase in the management of acute ischemic stroke. Methods: A cross-sectional study was conducted from January to June 2025 among 206 postgraduate residents from various public and private-sector hospitals of Khyber Pakhtunkhwa using a validated questionnaire adapted from Al Khathaami et al. Knowledge was evaluated using three fundamental criteria (effectiveness, standard of treatment, recommendation), resulting in a Knowledge Score from 0-3. Statistical investigations included t-tests, one-way ANOVA with post-hoc evaluations, and multivariable linear regression to identify the determinants of knowledge. Results: The average Knowledge Level Score was 2.81 ± 0.63, with 89.8% of individuals attaining the highest level. No notable differences were detected between inhabitants of public and private institutions (p = 0.882) or among residency years (p = 0.234). Multivariable regression indicated no significant determinants of knowledge (R² = 0.009, p = 0.880). Notwithstanding robust foundational knowledge, 10% of participants exhibited hesitance in endorsing tPA, attributing their reservations to worries over bleeding (52.9%), insufficient experience (35.0%), and medico-legal implications (3.4%). Notably, 86.4% indicated a readiness to pursue additional training, while 72.3% endorsed tele-stroke consulting methods. Conclusion: Postgraduate residents in Khyber Pakhtunkhwa exhibit substantial basic knowledge of intravenous alteplase in acute ischemic stroke, regardless of training year or type of institution. Obstacles to implementation originate from attitudes, self-assurance, and medico-legal issues.
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Junaid et al. (2026) conducted a cross-sectional in Postgraduate residents (assessing knowledge of acute ischemic stroke management) (n=206). Medical training and clinical exposure was evaluated on Knowledge Level Score (0-3). Postgraduate residents exhibited a high baseline knowledge of intravenous alteplase for acute ischemic stroke with an average score of 2.81 out of 3, though 10% expressed hesitance in endorsing it due to bleeding and medicolegal concerns.
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